Decision Pathway for Diabetes and Prediabetes
Key: CVD = cardiovascular disease; GDM = gestational diabetes mellitus; NIH = National Institutes of Health
1 Prediabetes identifies an intermediate stage in the development of type 2 diabetes. It is important to intervene at this stage to prevent progression.
2 Consider testing in overweight/obese (BMI ≥25kg/m2 or ≥23kg/m2 in Asian Americans) adults of any age with ≥1 of the following risk factors: first-degree relative with diabetes, history of CVD, high-risk race/ethnicity (eg, African American, Latino, Native American, Asian/Pacific Islander), hypertension (≥140/90mmHg or on therapy for hypertension), HDL <35mg/dL and/or TG >250mg/dL, polycystic ovary syndrome, physical inactivity, conditions associated with insulin resistance (eg, severe obesity, acanthosis nigricans), people with HIV. Consider testing in overweight/obese women, and/or who have one or more additional risk factors for diabetes who are planning a pregnancy. Test all women with prior GDM every 3yrs, and all other patients beginning at age 35yrs. In overweight/obese children or adolescents, and those with additional risk factors for diabetes, test after the onset of puberty or after 10yrs of age, whichever is earlier.
3 If tests are normal, repeat testing at a minimum of 3-yr intervals; more frequent testing depends on initial results and risk status.
4 Fasting is defined as no caloric intake for ≥8hrs.
Adapted from the National Diabetes Education Program: A program of the National Institutes of Health and the Centers for Disease Control and Prevention. Guiding principles for the care of people with or at risk for diabetes. https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/diabetes/guiding-principles-care-people-risk-diabetes.
American Diabetes Association. Standards of Care in Diabetes—2023. Diabetes Care. 2023;46(Suppl. 1):S1–S285.